| NPI | 1902465941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY R MCINTYRE Owner 317-512-0607 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 111N00000X Chiropractor |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2019-10-17 |